扩大右半结肠切除术在梗阻性结肠脾曲肿瘤中的应用  

Application of extended right colectomy in the treatment of obstructive splenic flexure tumours

作　　者：常顺伍[1] 吕云福[1] 

机构地区：[1]海南省人民医院胃肠外一科,海南海口570311

出　　处：《海南医学》2015年第18期2755-2757,共3页Hainan Medical Journal

基　　金：国家临床重点专科建设项目经费资助(编号:2012-649)

摘　　要：目的探讨扩大右半结肠切除术治疗结肠脾曲肿瘤并急性梗阻的临床疗效。方法回顾性分析我院2005年6月至2014年11月期间由同一术者实施的11例梗阻性结肠脾曲肿瘤行扩大右半结肠切除手术患者的临床资料,针对患者的手术时间、术中出血量、术后排气时间、住院时间、淋巴结清扫数目及术后吻合口瘘的发生率等方面进行观察。结果本组均除外Ⅳ期患者。11例患者TNM分期中ⅡC期2例,ⅢB期4例,ⅢC期5例。平均手术时间(195.7±17.1)min,平均术中出血量(272.6±54.8)ml,平均术后排气时间(4.2±2.6)d,平均住院时间(11.5±6.8)d,术后3个月平均每日排便次数为3.5次/d。淋巴结的中位清扫数为13.8枚,淋巴结阳性比例为44%。3例患者淋巴结清扫数不足12枚(27.3%)。11例患者手术切缘均为肿瘤阴性。术后无一例患者发生吻合口瘘。结论在充分掌握适应证的情况下,结肠脾曲肿瘤并急性梗阻行扩大右半结肠切除一期吻合术安全可行。Objective To evaluate the clinical efficacy of extended right colectomy in treating obstructive splenic flexure tumour. Methods The clinical and follow-up data of 11 patients who underwent extended right colectomy from June 2005 to november 2014 in our hospital were retrospectively analyzed. The operation time, intraoperative blood loss, postoperative exhausting time, length of hospital stay, number of lymph nodes dissected and incidence of postopera-tive anastomotic fistula were analyzed. Results According to the TNM staging, there were 2 phaseⅡC cases, 4 phaseⅢB cases, and 5 phase ⅢC cases. The mean operation time was （195.7 ± 17.1） min, intraoperative blood loss was （272.6.0 ± 54.8） ml, postoperative exhausting time was （6.2 ± 2.3） d, length of hospital stay was （11.5 ± 6.8） d, and stool fre-quency was 3.5 times per day 3 months after the surgery. The median number of dissected lymph nodes was 13.8, with pos-itive lymph nodes in 44%of patients. The proportion of patients with〈12 dissected lymph nodes was 27.3%. All patients had negative resection margins. And postoperative anastomotic fistula developed in no patients. Conclusion Extended right colectomy for patients with obstructive splenic flexure tumours is feasible and safe.

关 键 词：扩大右半结肠切除术 结肠脾曲肿瘤 肠梗阻 

分 类 号：R656.9[医药卫生—外科学]